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It is not unusual to have vitamin deficiencies following gastric bypass surgery. As a matter of fact, it is so common that patients who have had weight-loss surgery should pretty much anticipate taking vitamin supplements for the rest of their lives.

Vitamin deficiencies after bariatric surgery may include vitamins A, B, C, D, E and K. Calcium and vitamin D deficiencies are often present prior to gastric bypass surgery and are often co-morbidities of obesity. Weight-loss surgery often exacerbate these conditions.

Contributing Factors to Vitamin D Deficiency After Gastric Bypass

Bypassing the small intestine is a component of gastric bypass surgery. Because most vitamins and minerals are absorbed in the small intestine, a lesser amount of these vitamins and minerals are absorbed when the intestine is shortened.

Vitamin D is needed for calcium absorption. Low levels of vitamin D have also been related to cancer, osteoporosis, and cardiovascular diseases.

Vitamin D and Energy Levels After Gastric Bypass

Vitamin D deficiency has often leads to complaints of fatigue, exhaustion, mood changes, and depression. Vitamin D deficits have a pronounced effect on energy and vitality. Vitamin D also plays a role in seasonal affective disorder, a winter malady characterized by depression due to the limited amount of sunshine in the winter months. Those gastric bypass patients who spend extended periods exposed to sunshine are much less at risk for Vitamin D deficiency because the sun is a natural source of Vitamin D.

Osteoporosis and Vitamin D Deficiency

Vitamin D is important for building and maintaining strong bones. Young people need Vitamin D to build sturdy bones and older adults need Vitamin D to maintain bone strength. Vitamin D deficiency lowers bone mass which can cause bones to break more easily. This thinning of bone tissue and density is osteoporosis.

The Risk of Hypocalcaemia After Gastric Bypass

Hypocalcaemia is a low blood calcium level. Although only a few cases of hypocalcaemia have been reported following gastric bypass, the changes in the metabolism of calcium and Vitamin D make hypocalcaemia a possibility for gastric bypass patients.

Because of the weight-loss surgery that has been performed, calcium is absorbed less efficiently as is Vitamin D. Vitamin D deficiency impairs calcium absorption that much more, and the risk for hypocalcaemia increases.

Sources of Vitamin D

Vitamin D is most easily attained from the sun. Given the prevalence of indoor professions and the hustle and bustle of everyday living, we do not get as much sunshine a we should. Therefore, other resources are necessary.

A vitamin D3 supplement is an excellent option and is available at any local drug store or food mart.

Food that are high in Vitamin D are shiitake and button mushrooms, mackerel, salmon, sardines, herring, catfish, tuna, and eggs.

Vitamin D and Calcium Requirements Following Gastric Bypass Surgery

It is believed that calcium citrate improves the absorption of calcium. The general recommended daily dose of calcium citrate is 1500 to 2000 mg. and is taken three times per day in doses of 500 to 600 mg. Check with your bariatric surgeon or nutritionist for their recommended daily dosages.

According to the Institute of Medicine (IOM) the majority of US citizens have an acceptable level of vitamin D within their blood levels. This was rated at 20 nanograms per milliliter. Even so, there is evidence that levels on closer to 30 nanograms per milliliter or even higher would be more beneficial. At this level, the body would be better able to protect vital systems such as bones and might even be able to lower colon cancer risks as well as other disease. This higher level of vitamin D is also considered safe and can be achieved by taking supplements that contain between 800 and 1000 IU in vitamin D. For those who may have lower levels of vitamin D, 2000 IU of daily supplement may be necessary.

IOM Findings Debate on Vitamin D Supplements

The findings of the IOM, however, are no without some debate. Their recommendation that 600 IU of vitamin D a day is considered by some to be somewhat misleading and some go so far as to suggest that those findings do not make sense. Case in point:

The IOM report contained suggestions that certain people (infants who are breastfeeding and especially those of dark skin) are at a higher risk of vitamin D deficiency. The report also suggested that older individuals who may reside in institutions may be at risk as well and should be monitored for any signs of vitamin D deficiency. It went on to say that those who do not eat animal products or forms of diary should consider adding a vitamin supplement to their daily diet to prevent problems with a lack of this important vitamin. It did not, however, go on to suggest or recommend that the population, as a whole, include vitamin D supplements as a daily part of their diet. It also left out certain other groups of people who may be at risk such as those who are obese; those who are dark skinned, or those who simply do not get enough direct sunlight.

The main point of the debate concerning the IOM report is that it did include data that was based on research conducted by the National Health and Nutrition Examination Survey that found that nearly 11 percent of white and 54 percent of African-Americans do have levels of vitamin D that are below the minimal 20 nanograms per milliliter. What this means, is that millions of US citizens currently have vitamin D levels that are too low. Ironically, these numbers would be much higher if 30 percent of Americans who are currently using vitamin D supplements were not doing so. The numbers would have been higher as well if the survey has reported on those who live in the Northern part of the US who often have low vitamin D levels during the winter months.

The IOM committee did acknowledge that getting a daily dose of 600 IU of vitamin D through consumption of food alone was rare for most people. Their conclusion, even after this acknowledgment, that US citizens are getting what they call the average requirements of this vitamin is yet another reason some debate the report as being somewhat misleading or confusing. One issue pointed out by those who disagree with the findings is that if half the population is just getting the minimal amount of vitamin D, the other half of the population is below that level, which should be a cause of concern.

This brings up the question of how people truly do get their vitamin D. The committee suggested that most people get at least some of their D vitamin via direct sunlight exposure. While this may be true, unprotected exposure to the Sun can increase the risk of skin cancer and most medical experts do not recommend this as the best way to get the vitamin. This leads to the problem with the IOM report: If people are not getting vitamin D via diet and should not spend excessive amounts of time in direct sunlight, how should they get the vitamin and why the suggestions that people not use vitamin D supplements?

Are High Blood Levels of Vitamin D an Issue?

Some of those who are debating the report suggest that the committee overstated its concerns regarding high levels of vitamin D while diminishing the health benefits of the vitamin when taken as a supplement.

An example of this was illustrated with the IOM report findings that there is a relationship between high levels of vitamin D and early death. The report focused on cases where the blood levels were above 70 nanograms per milliliter, but the death rates for those cases was reported as being only slight. The committee spent little time on the reverse where studies show that death rates steadily decrease as vitamin D levels increase toward the 40 nanogram per milliliter level. Few people have blood levels of the D vitamin above 40 nanograms per milliliter and as such there is not much data on the death rates of these individuals. Overall, the majority of studies suggest that mortality rates decrease when the blood level is between 40 and 70 nanograms per milliliter. Only a few studies suggest the opposite.

In a press release put out by the IOM, they also suggested that other types of vitamin supplements such as beta carotene antioxidants as well as vitamin E were thought to be beneficial to health when they first came out, but were later found to be ineffective in terms of improved health. The basis of their conclusion was thought by many to be flawed in that the studies cited used extremely high dosages of these substances (10 to 20 times more than provided by a regular diet).

Vitamin D, on the other hand, is different. Even a small amount of time in direct sunlight can produce as much as the equivalent of 10,000 IU’s. Our ancestors, who spent much more time outdoors and in less clothing than we do, surely had to have high levels of vitamin D in their blood. If one thinks about it, a vitamin D supplement of 1,000 to 2,000 IU a day can be considered a modest dose, and for some people, may be lower than what they truly need.

Vitamin D Supplements: People Need Them

It should come as no surprise that modernday men and women need more vitamin D in order to remain healthy. Consider the International Osteoporosis Federation’s vitamin D recommendations in which they recommend taking a vitamin D supplement in the range of 800 to 1,000 IU’s each day. They report that this level will help most individuals to reach what they consider to be adequate blood levels of vitamin D. They recommend 30 nanograms per milliliter. This is a safe level to take on a daily basis and is much lower than the upper limit of 4,000 IU’s. Most good-quality supplements and multivitamins already contain between 800 and 1,000 IU’s of this important vitamin.

Individuals should check their supplements to see that they are getting at least 800 IU’s a day. Those who are “at risk” of deficiency should consider taking 2,000 IU’s of vitamin D. Some individuals may need even more than that. At risk individuals include dark skinned men and women, those who are obese and elderly individuals. Before doing so, discuss the dose and use of supplements with your health care provider.

For those who want more information on their blood levels of vitamin D, consider getting a vitamin D blood test. This could be a good idea for those who may be at risk of getting too much vitamin D from the sun.

Recent studies suggest that vitamin D is much more important in fighting off disease than previously thought. Being deficient in this vitamin puts one at risk of diseases such as cancer, osteoporosis, and multiple sclerosis. Chances are that if you live in a northerly geographic region you do not get enough vitamin D. Persons who live a rather sedentary lifestyle and do not get outside for at least a 15-minute daily walk in the sun are in the same position. Latinos, African-Americans and others with dark skin tend to have much lower levels of vitamin D, as do people who are overweight or obese. All around the world millions of persons suffer from vitamin D deficiency. This phenomenon is so common that it affects persons on every continent, of all ethnic groups, and across all ages. Some surveys suggest that perhaps half of the world’s population has inadequate blood levels of vitamin D. Sadly, physicians, even in industrialized countries, are seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification.

As with most research findings, there is plenty of debate. Indeed, as opposed to what many people think, there are few certainties in science; its nature is to be open to criticism, discussion, and revision. The Institute of Medicine (IOM) released a report in November 2010 which recommends a daily vitamin D intake of 600 IU per day, for people ages 1 to 70, and 800 IU, for people over age 70—the report referred to persons living in the U.S. and Canada. The report also recognized the safety of vitamin D by increasing the upper limit from 2,000 to 4,000 IU per day, and acknowledged that even at 4,000 IU per day, there was no good evidence of harm.

Some in the scientific community believe the new guidelines are too conservative about the intake, and that they do not give due consideration to the latest findings about vitamin D and health. They contend that the new guidelines are not enough to prevent chronic disease, and they are not sufficient to help those who have problems with their bones. This is an important debate, and in order to understand it better it is necessary to know the origins of vitamin D and how it functions in the human body.

Vitamin D Sources and Function

Our body makes vitamin D and it is also a nutrient we eat. The body produces vitamin D from cholesterol, which itself is triggered by sun lighting on the skin. Yet many persons do not make enough vitamin D from the sun, persons with darker skin, those who are overweight, and persons who use products that block sunlight being among them. Correctly applied sunscreen reduces our ability to absorb vitamin D by more than 90 percent.

To be sure, not all sunlight is of the same quality and intensity: The sun’s ultraviolet B (UVB) rays—the so-called “tanning” rays, and the rays that trigger the skin to produce vitamin D—are stronger near the equator and weaker at higher latitudes. Indeed, persons who live in places prone to considerable cloudiness and rain can suffer from vitamin D deficiency. The other way we get vitamin D is to eat food that contains a lot of it. However, few foods are naturally rich in vitamin D, so the biggest dietary sources of vitamin D are fortified foods and vitamins supplements.

Vitamin D helps the body absorb and retains calcium and phosphorus, which are critical elements for building bone. Laboratory studies show that vitamin D can reduce cancer cell growth, can increase muscle strength, and can help control infections. There may yet be other functions for vitamin D, and scientists continue to explore the many other uses for this important substance.

New Vitamin D Research: Beyond Building Bones

Vitamin D research has proved to be of considerable fecundity. Although there have been many reports issued over the years, there are only a few that offer enough evidence to constitute a clear medical breakthrough. Here we provide the more promising areas of vitamin D research, highlighting the complex role of vitamin D in disease prevention—and the many unanswered questions that remain.

Vitamin D and Bone and Muscle Strength

A number of random trials have shown that high doses of vitamin D supplements help reduce bone fractures. A summary of the evidence comes from a combined analysis of 12 fracture prevention trials that included more than 40,000 elderly people, most of them women. Researchers found that high intakes of vitamin D supplements—of about 800 IU per day—reduced hip and non-spine fractures by over 20 percent, while lower intakes (400 IU or less) failed to offer any fracture prevention benefit.

It has been shown that vitamin D may also help increase muscle strength, which can help prevent elderly persons from falling, a common problem that leads to increased rates of disability and death among them. A combined meta-analysis found that taking 700 to 1,000 IU of vitamin D per day lowered the risk of falls by 19 percent; the combined studies also show that taking 200 to 600 IU per day offered no such protection. Based on this data, the International Osteoporosis Foundation recommends that adults over age 60 maintain vitamin D blood levels of 30ng/ml. This means that most people will need vitamin D supplements of at least 800 to 1,000 IU per day, and possibly higher, to reach these levels.

Vitamin D and Heart Disease

The heart, as a skeletal muscle, is a receptor of vitamin D. A number of studies have found that lack of vitamin D is linked to heart disease. The Health Professional Follow-Up Study observed the vitamin D blood levels in nearly 50,000 men who were healthy. They followed the same group for 10 years and found that men who were low in vitamin D were twice as likely to have a heart attack as men who had adequate levels of vitamin D. Other studies have linked low vitamin D levels to an increased of heart failure, sudden cardiac death, stroke, overall cardiovascular disease, and cardiovascular death. There is some evidence that vitamin D plays a vital role in controlling blood pressure and preventing artery damage. This goes some ways in explaining the findings above. However, more research is needed before a sounder conclusion can be made.

Vitamin D and Cancer

Nearly 30 years ago, researchers discovered an interesting correlation between colon cancer deaths and geographic location. They found that people who lived at higher latitudes, such as in the northern U.S. or Canada, had higher rates of death from colon cancer than people who lived closer to the equator. The sun’s UVB rays are weaker at higher latitudes, and in turn, people’s vitamin D levels in these high latitude locales tend to be lower. Researchers formed the hypothesis that vitamin D deficiency can lead to an increased risk for getting colon cancer

Some time has passed, but dozens of studies suggest a relationship does exist between low vitamin D levels and increased risks of colon and other cancers. The evidence is strongest for colorectal cancer, with observational studies have found that persons with lower vitamin D levels are at higher risk of getting such diseases. Vitamin D levels may also predict cancer survival, but there is as yet little evidence to support this. However, it is not yet certain that taking vitamin D supplements necessarily lowers the risk of contracting cancer. This latter idea will be tested in the VITAL trial. The VITAL trial will look specifically at whether vitamin D supplements lower cancer risk. However, it is likely to be years before the trial produces any results. Additionally, the VITAL trial could fail to detect a real benefit of vitamin D. There are several reasons for this. First, if people in the placebo group decide to take their own vitamin D supplements, the differences between the placebo group and the supplement group could be minimized. Second, the study may not follow participants for a long enough time to show a cancer prevention benefit; or study participants may be starting supplements too late in life to lower their cancer risk.

In any case, given the evidence now on hand, 16 scientists have circulated a “call for action” on vitamin D and cancer prevention. Given the high rates of vitamin D inadequacy in North America, the strong evidence for reduction of osteoporosis and fractures, the potential cancer-fighting benefits of vitamin D, and the low risk of vitamin D supplementation, these scientists recommend vitamin D supplementation of 2,000 IU per day. The Canadian Cancer Society has also recommended that Canadian adults consider taking vitamin D supplements of 1,000 IU per day during the fall and winter. They also recommend that people who are at high risk of having low vitamin D levels because of old age, dark skin, or geographic location take vitamin D supplements year round.

During the winter, it’s easy to hide out indoors, but staying inside could have a huge impact on your health. A little sun gives you more than you know.

Sunshine … most of the country misses it this time of year, but by staying inside, you could depriving your body of something very important. Seasonal Affective Disorder, or the winter blues, is also attributed to not enough vitamin D. A supplement can do the trick or a light box can brighten your mood.

Vitamin D can also help your heart. Doctors at the University of Michigan found the higher the vitamin D level, the higher the good HDL cholesterol. Women between the ages of 50 to 69 should get 300 units a day. If you’re over age 70, you should get 600 units. That equals just 10 to 15 minutes of sunshine three times a week.

So bundle up, get outside and soak up the vitamin D!

You can get vitamin D from foods such as milk and fatty fish like salmon and vitamin fortified juices.

Within the last decade, in addition to its protective attributes for bones, vitamin D3 has also been recognized as a key protector against heart disease. A study from 2004 showed that men with low vitamin D3 levels were twice as likely as men with normal levels to suffer heart attacks. Vitamin D3 aids vascular health in many different ways, one of the most important of which is its reduction of the chronic inflammatory reactions associated with atherosclerosis.

Getting enough vitamin D3 is also one of the easiest deficiencies to address, since our bodies can usually produce it on their own if we get the minimum sunlight every day. However, as we age, we lose the ability to adequately convert sunlight to vitamin D3, and too much sunlight may predispose us to skin cancers, including melanoma, basal cell carcinoma, and squamous cell carcinoma. It is not so with vitamin D3 supplements, however. It is recommended to either take 2,000-6,000 IU of vitamin D3 every day, depending on your vitamin D3 lab test, or getting the equivalent in sunshine, which would be about fifteen to twenty minutes of sunshine a day if cleared by your doctor. A vitamin D3 level below 32 ng/ml is considered low; however, try to get vitamin D3 level in the optimal range, which is 50-100 ng/ml.

Low vitamin K2 levels

The “K” in vitamin K2 is derived from the German word koagulation, because of the vitamin’s importance in blood clotting in case of an injury. However, a secondary benefit of vitamin K2 is that it regulates proteins in the bloodstream that guide calcium to deposit into the bones rather than in artery walls. Thus it is an important compound for preventing arterial calcification, chronic inflammation, and in lowering the risk of heart attacks.

Being deficient in vitamin K1 is not common for a number of reasons. One reason is that it is widespread in ordinary foods such as green, leafy vegetables. Vitamin K2 is present in egg yolks, dairy products, and organ meats, all of which raise cholesterol levels and is therefore commonly deficient in many Americans at risk for heart disease. In areas of Japan, a dish called natto, which is fermented soybeans, is usually eaten a few times a week. It is high in vitamin K2 and especially the MK-7 type of vitamin K2. According the 2004 Rotterdam Heart Study that followed 4,800 subjects for seven years, the subjects that are the most vitamin K2 in their diet had a 57 percent reduction in death from cardiovascular disease. This study suggested that vitamin K2 gives cardiovascular benefits by inhibiting arterial calcification.

Those most at risk for vitamin K deficiency are those taking anticoagulant drugs (such as Coumadin), who are unable to take vitamin K or foods containing vitamin K, or individuals who have liver damage or disease. Research has also shown that people who have fat malabsorption disorders may also be at risk of low vitamin K levels.

The importance of vitamin D in calcium metabolism and bone health is well recognized but more recently, its role in cardiovascular health, immune function, glucose metabolism, and cell differentiation and proliferation have been defined. It is well established that vitamin D deficiency leads to rickets in developing children but more current research has also linked vitamin D deficiency with osteoporosis, osteomalacia, impaired muscle function, infection, autoimmune disorders, diabetes, and some cancers in adults. Vitamin D is unique among other vitamins in that very little is obtained through a normal diet.

Once you are diagnosed with cancer, does it help to take vitamin D supplements?

We don’t know whether increasing vitamis D once a diagnosis of cancer is made provides any benefit in reducing the growth of the cancer or the cancer’s outcome. However, there is no reason not to have all cancer patients take enough vitamin D to maintain their blood level of vitamin D between 30 and 100 nanograms per milliliter. It may improve muscle strength and bone strength as well as possibly enhancing the therapeutic benefit of any cancer treatment. Patients with cancer often have aches and pains in their bones, muscles, and joints, as well as gastrointestinal upset. Curing them of a vitamin D deficiency can help. Studies have shown that cancer patients are typically deficient. They have also demonstrated in mice that colon and prostate cancer cell growth is less in mice receiving adequate vitamin D.

Are vitamin D supplements safe during chemotherapy, or could they interact with the action of these agents?

There is no evidence that vitamin D supplements will interact with chemotherapy. Therefore, vitamin D supplementation is safe during chemotherapy.

Is it necessary to have vitamin D levels between 60 and 80 nanograms per milliliter to prevent cancer?

It does appear that a blood level of vitamin D is at least 30 nanograms per milliliter may decrease the risk of many deadly cancers. It is unknown, however, the blood level needs to be 60 nanograms per milliliter. There is no harm in keeping the blood level at between 60 and 80 nanograms per milliliter.

Is vitamin D deficiency linked to thyroid disease?

Vitamin D deficiency does not cause thyroid disease, but patients with hyperthyroidism (an overactive thyroid that leads to an imbalance of the body’s metabolic hormones, tripping a cascade of health problems) have increased destruction of vitamin D and are at higher risk of vitamin D deficiency.
Is there any correlation between vitamin D deficiency and hypothyroidism (an underactive thyroid)?

There is no correlation between vitamin D deficiency and hypothyroidism. Vitamin D deficiency is so common that often patients with hypothyroidism are also vitamin D deficient. All patients, including hypothyroid patients, should be treated for their vitamin D deficiency and prevent vitamin D deficiency by staying on an adequate amount of vitamin D.

When children raised in equatorial areas move to the United States and develop high rates of autism, could this be related to Vitamin D deficiency?

There is little information regarding the cause of autism, and there has been a suggestion that vitamin D deficiency may increase risk of it. However, to date there have not been any clinical trials demonstrating that vitamin D improves autism. However, it is important that everyone, including children with autism, have an adequate amount of vitamin D to maintain their blood level of vitamin D of between 30 and 100 nanograms per milliliter.

Is there any evidence that treating patients with autoimmune disease with vitamin D can lessen their symptoms?

There are no prospective studies that have treated patients with autoimmune diseases with high doses of vitamin D, so we do not know whether such treatment would lessen their symptoms. However, vitamin D deficiency is associated with many nonspecific symptoms, including muscle weakness, muscle aches and pains, bone aches and pains, and joint aches and pains, which can be associated with autoimmune diseases including multiple sclerosis and rheumatoid arthritis. Not only does treating patients with multiple sclerosis with vitamin D improve their overall feeling of well-being and muscle strength, but some of the patients also have had an extended honeymoon from their disease. Patients with rheumatoid arthritis who are vitamin D deficient also have improvement in muscle function and decreased aches and pains in their bones and joints when the deficiency is treated.